The voices of Urban Institute's researchers and staff
May 21, 2014

How do you improve the health of millions of women? Start with where they live.

The lives of women in the United States are not what they could be—not in length and not in quality. American women suffer from much poorer health than our counterparts in other developed countries. In life expectancy, we’re nearly last among high-income countries. This longevity gap has been widening for 30 years.

Obesity, diabetes, and cardiovascular disease are among the top health problems facing American women, and they’re all more prevalent among the poor.

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So what if there were a single platform that could help us reach millions of the most economically disadvantaged women in the country as we work to reverse this decades-long trend? Fortunately, there is: federally assisted housing. Federal housing assistance serves 4.6 million adults, more than three-quarters of them women.

Assisted housing can help improve women’s health in at least three broad ways. First are the benefits of being safely and stably housed. We know that households fortunate enough to receive housing assistance are less likely than other low-income households to experience periods of homelessness, which have devastating health consequences. Housing assistance also promotes housing stability by making rents more affordable and reducing the risk of eviction or forced moves. It also leaves families with more money to spend on food.

Second, considerable past research has shown that living in a high-poverty or high-crime neighborhood is associated with poor health, including heart disease, obesity, and premature death. It’s one of many reasons that some local housing authorities are using housing vouchers to help poor women move from dangerous and distressed neighborhoods to healthier environments. When women use housing vouchers to relocate to safer, lower-poverty neighborhoods, their rates of diabetes and severe obesity decline significantly.

Finally, once women are stably housed, assisted housing can be a bridge connecting them to programming that supports better physical and mental health. For example, the Chicago Family Case Management demonstration used housing as a platform to improve health outcomes among public housing residents in Chicago. At the start of this demonstration, 53 percent of adults rated their health as fair or worse. After two years, this figure had dropped to 48 percent, and after another two years, it had dropped an additional 10 percentage points to 38 percent.

Several public housing authorities are partnering with local public health agencies to improve residents’ diets and encourage physical activity. The Every Heartbeat is Life initiative, led by the National Heart, Lung, and Blood Institute, aims to increase the utilization of community health workers to address cardiovascular disease. It builds partnerships and deploys resources already in place in communities with health disparities.

Bringing disease rates down for poor women would not only improve their quality of life—it would also substantially reduce national health care costs. The costs of treating diabetes, hypertension, heart disease, stroke, and renal disease are mind-bogglingly high—and rising. Recent estimates put them at almost $240 billion annually and project that by 2030, they'll exceed $465 billion per year. Almost two-thirds will be paid by Medicare and Medicaid.

The potential savings from even marginal improvements are enormous. One recent study estimates that $24.7 billion in excess medical spending would be avoided annually from just a 5 percent reduction in diabetes and hypertension.

These efforts are all part of a much broader and growing body of policy and practice that recognizes the importance of our homes and neighborhoods in shaping our well-being. Assisted housing does far more than just put a roof over the heads of the poor. It can play a major part in efforts to improve women’s health and bend the curve of health care costs.

The Assisted Housing Initiative is a project of the Urban Institute, made possible by support from Housing Authority Insurance, Inc.  (HAI, Inc.), to provide fact-based analysis about public and assisted housing. The Urban Institute is a non-profit, nonpartisan research organization and retains independent and exclusive control over substance and quality of any Assisted Housing Initiative products. The views expressed in this and other Assisted Housing Initiative commentaries are those of the authors and should not be attributed to the Urban Institute or HAI, Inc.

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